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Surgeon General Gets Rough Treatment in Senate

Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.
University of South Florida
The Florida Channel
Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.

In another sign of growing tension about a Senate plan to expand health coverage for low-income Floridians, a Senate committee Tuesday tabled the confirmation of state Surgeon General John Armstrong after questioning him about the issue.

The move by the Senate Health Policy Committee came a day after Gov. Rick Scott --- Armstrong's boss --- opposed the plan to use federal money to provide health coverage to an estimated 800,000 Floridians through a private insurance system.

Armstrong went before the committee for what would ordinarily have been a routine confirmation hearing. But he faced a series of questions from Sen. Don Gaetz, R-Niceville, and Senate Minority Leader Arthenia Joyner, D-Tampa, about his views on the expansion plan.

The surgeon general, who is secretary of the Florida Department of Health, appeared to try to deflect the questions, at one point saying he had not "formulated an opinion:" on the Senate plan.

Senate Majority Leader Bill Galvano, R-Bradenton, made a motion to "temporarily postpone" the confirmation hearing --- a procedural move that essentially tables the matter. Committee Chairman Aaron Bean, R-Fernandina Beach, then said the panel would ask Armstrong to come back for another hearing. Armstrong left the committee room.

After the meeting, Galvano pointed to questions that senators asked about the health-care expansion plan.

"There was not an adequate answer, and I think the members were frustrated,'' he said.

The episode came amid a sharp divide between the Senate and House about whether to provide health coverage to uninsured Floridians by tapping into billions of dollars available under the federal Affordable Care Act, better known as Obamacare.

The Affordable Care Act included the money for states to expand Medicaid. Republican senators have tried to distance their plan from being perceived as a Medicaid expansion, but the plan would use the same federal money to provide care through private health plans.

House Republican leaders have adamantly opposed the idea, and Scott joined them Monday by raising questions about whether Florida could count on the federal money. Scott framed his concerns by citing questions about whether Florida will continue receiving federal money for a key health-care program known as the Low Income Pool.

Scott's opposition increases the likelihood that the expansion plan will die. But Galvano said senators will continue pushing for the plan, which the Senate argues would help mitigate the potential loss of money under the $2.2 billion Low Income Pool program. That program provides additional funds to hospitals and other health providers that care for large numbers of low-income and uninsured patients.

"We're not retreating from our position," Galvano said. "We're comfortable with what we put together."

Armstrong's department is not a key player in the Low Income Pool issue and does not run the Medicaid program. The Agency for Health Care Administration has led negotiations with the federal government to try to extend the so-called LIP program and administers Medicaid.

But the Senate committee appeared to be trying to send a message to Scott with its questioning of Armstrong. Bean said he expects to bring back Armstrong to the committee next week. Armstrong has been surgeon general since 2012 but needs to go through another confirmation hearing because he was reappointed after Scott won re-election.

The confirmation hearing initially was courteous, with Gaetz alluding to Armstrong's military service and the likelihood that the physician could earn more money in the private sector.

"You are sacrificing financially and in other ways to serve the state of Florida,'' Gaetz said.

But then Gaetz, a former Senate president, asked questions aimed at trying to get Armstrong to comment about whether the expansion plan would help improve health outcomes in the state. Armstrong did not offer opinions on the issue, saying that he is monitoring the discussions and that it is "ultimately a conversation" between the Legislature and Scott.

"But as a physician and as the primary health officer of this state, you have no opinion as to whether or not additional health-care coverage is good for health-care outcomes?" Gaetz asked.

"I am mindful of the thoughtful conversations that are occurring in the Legislature and am carefully reflecting on how those conversations and results could ultimately impact the health of the people of Florida,'' Armstrong said.

Later, Joyner asked Armstrong whether he had been constrained by Scott or anybody else from expressing his opinions.

"I am under no constraints before this committee," Armstrong replied, adding that he is focused on issues such as how people's behaviors, socioeconomic circumstances and environments affect their health.